This invention relates to medical apparatus and methods, and more particularly to apparatus and methods for installing a tubular graft in a patient for such purposes as bypassing an occlusion in the patient""s tubular body conduit structure.
Goldsteen et al. U.S. patent application Ser. No. 08/745,618, filed Nov. 7, 1996, which is hereby incorporated by reference herein in its entirety, shows, among other things, apparatus and methods for installing a graft conduit in a patient, with most or all of the work being done intraluminally through the patient""s existing body conduit structure. Testing and further development work have suggested that it would be advantageous to improve and/or augment some aspects of apparatus and/or methods of the kind shown an the above-mentioned Goldsteen et al. reference.
In view of the foregoing, it is an object of this invention to improve and simplify various aspects of apparatus and methods of the general type shown in the above-mentioned Goldsteen et al. reference.
It is another object of this invention to provide additional and/or alternative apparatus and/or methods for certain aspects of technology of the general type shown in the Goldsteen et al. reference.
These and other objects of the invention are accomplished in accordance with the principles of the invention by providing improved apparatus and methods for installing a guide structure in a patient between two locations along the patient""s circulatory system that are to be connected by a bypass graft. The guide structure extends between those two locations outside the circulatory system (albeit within the patient) and is used to guide the bypass graft into place between those two locations. The guide structure is preferably installed in the patient intraluminally (i.e., via lumens of the patient""s circulatory system), although there is a portion of the guide structure which ultimately extends outside the circulatory system as mentioned above. A portion of the guide structure may be re-routable in the circulatory system to improve the alignment of the guide structure for purposes of optimal guidance of the bypass graft into place. For example, the guide structure may be re-routed so that, whereas both ends of the guide structure initially extend out of the patient, only one end of the re-routed guide structure extends out of the patient, while the other end of the guide structure dead-ends in the patient. Again, the new routing of the guide structure may improve its ability to guide the bypass graft into a desired alignment in the patient.
Improved apparatus and methods for delivering a bypass graft conduit into the patient along the guide structure are also provided. For example, the graft delivery structure may include a very gradually tapered distal nose portion to facilitate entry of the apparatus into the patient""s circulatory system at one end of the graft installation site. Improved connectors for attaching one or both ends of the graft conduit to the patient""s circulatory system may also be used.